A 62-year-old man is diagnosed with a T3N1M0 rectal carcinoma at 8 cm from the anal verge. Total mesorectal excision (TME) is planned. What is the standard neoadjuvant treatment according to current guidelines?
- A Long-course chemoradiotherapy (45-50.4 Gy with concurrent fluoropyrimidine) followed by TME after 6-8 weeks ✓
- B Short-course radiotherapy (25 Gy in 5 fractions) alone followed by immediate surgery
- C Systemic chemotherapy with FOLFOX for 3 months followed by surgery
- D Upfront TME followed by adjuvant chemoradiotherapy
Correct answer: A. Long-course chemoradiotherapy (45-50.4 Gy with concurrent fluoropyrimidine) followed by TME after 6-8 weeks
Explanation
For locally advanced rectal cancer (T3/T4 or N+), standard neoadjuvant treatment is long-course chemoradiotherapy (45-50.4 Gy over 5-6 weeks with concurrent capecitabine or 5-FU) followed by TME surgery 6-8 weeks later to allow tumour downsizing and downstaging. Short-course RT (Swedish technique) is also acceptable particularly when surgical delay is not needed for downsizing. The RAPIDO and PRODIGE 23 trials have explored total neoadjuvant therapy (TNT) approaches. TME alone without neoadjuvant therapy has higher local recurrence rates for node-positive disease.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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